Dermatological Manifestations in the Intensive Care Unit: A Practical Approach

Abstract

Dermatological problems are not usually related to intensive medicine because they are considered to have a low impact on the evolution of critical patients. Despite this, dermatological manifestations (DMs) are relatively frequent in critically ill patients. In rare cases, DMs will be the main diagnosis and will require intensive treatment due to acute skin failure. In contrast, DMs can be a reflection of underlying systemic diseases, and their identification may be key to their diagnosis. On other occasions, DMs are lesions that appear in the evolution of critical patients and are due to factors derived from the stay or intensive treatment. Lastly, DMs can accompany patients and must be taken into account in the comprehensive pathology management. Several factors must be considered when addressing DMs: on the one hand, the moment of appearance, morphology, location, and associated treatment and, on the other hand, aetiopathogenesis and classification of the cutaneous lesion. DMs can be classified into 4 groups: life-threatening DMs (uncommon but compromise the patient's life); DMs associated with systemic diseases where skin lesions accompany the pathology that requires admission to the intensive care unit (ICU); DMs secondary to the management of the critical patient that considers the cutaneous manifestations that appear in the evolution mainly of infectious or allergic origin; and DMs previously present in the patient and unrelated to the critical process. This review provides a characterization of DMs in ICU patients to establish a better identification and classification and to understand their interrelation with critical illnesses.

Dermatological manifestations in the intensive care unit of a third‐level hospital

“…Other groups have also encountered this finding. 9,17 ASF represents the most advanced state of cutaneous barrier impairment that leads to insensible water losses, temperature dysregulation, hemodynamic compromise and an increased risk of infectious complications. 18,19 Skin diseases that lead to ASF include pemphigus vulgaris, erythroderma, TEN and staphylococcal scalded skin syndrome.…”

The impact of glucocorticoids therapy on cutaneous wounds in Kawasaki disease: A meta‐analysis of randomized controlled trials

“… 22 While the impact of glucocorticoids on the resolution of systemic manifestations has been extensively studied, there remains a paucity of comprehensive analyses focusing specifically on their effect on cutaneous manifestations, notably skin wounds. 23 …”

An Overview of Clinical Manifestations of Dermatological Disorders in Intensive Care Units: What Should Intensivists Be Aware of?

“…Dermatological manifestations (DMs) in critically ill patients are receiving increased attention in intensive care medicine in order to obtain an accurate diagnosis at the right time. Without appropriate knowledge and greater awareness of the various pathophysiological aspects and clinical presentations of skin diseases, their interpretation is typically difficult for intensive care physicians [ 1 , 2 , 3 ].…”

“…Skin manifestations in meningococcal sepsis [ 7 ] and ecthyma gangrenosum in Pseudomonas aeruginosa infection [ 8 , 9 ] are two examples. Other times, DMs reflect secondary effects of devices or procedures or they are simply due to the patient’s critical condition [ 1 ]. Nonetheless, DMs can present in a variety of ways, and a definitive diagnosis frequently necessitates the collaboration of a dermatologist [ 10 ].…”